CHOIR REGISTRATION

Size: px
Start display at page:

Download "CHOIR REGISTRATION"

Transcription

1 CHOIR REGISTRATION Please Print Clearly All Information will be input into our Data Base Choir you are in: (circle) Jubilate Bel Canto Kantorei Angelica Cantus Last Name: _ First Name: M / F Birth Date: / / Address: City: State: Zip: Home Phone: Grade you will be in this fall: School you will attend this fall: _ Singer s Cell Phone: Singer s _ PARENT S/GUARDIAN S INFORMATION: Parent s Primary Secondary/Work Father s/guardian s Name: Father s Cell Phone: Father s Place of Employment: Work Phone: Position: May call Father at work: Yes or No Mother s/guardian s Name: Mother s Cell Phone: _ Mother s Place of Employment: Work Phone: Position: May call Mother at work: Yes or No Does your place of employment use advertising? Father: Yes or No Mother: Yes or No Would you be willing to ask them to purchase sponsorship in our brochure? Father: Yes or No Mother: Yes or No EMERGENCY CONTACT INFORMATION: Name/Relation: _ Phone: Medical Information: We ask that you help us take the best possible care of your child by answering the following questions: Does your child take any prescription medication? Yes or No If so, please list: Does your child have any medical conditions? Yes or No If so, please list: 1

2 CDCC Policies Attendance Policy As a result of the audition process, membership in this choir is an honor. This is to be considered a year long commitment towards the success and growth of the choir. Each member is an important part of this group experience; therefore, the progress of this group depends on your consistent attendance. Students will be allowed no more than 3 unexcused absences or 6 tardies. An excused absence would be for sickness (notify ASAP), death of a family member, or upon advance notice and approval of the director. Students exceeding these limits will be asked to leave the choir. Tuition Policy If a student s tuition has not been paid, that student will not be allowed to attend rehearsal until such time as tuition is paid. Each missed rehearsal will be considered unexcused. After three unexcused absences, the student s position will not be held. Any tuition not paid by July 31, 2015 will be assessed a $30 late fee. If you foresee difficulty meeting this payment schedule, please contact our office immediately. We will make every effort to work with you, but a payment plan must be established prior to July 31, Please do not wait until after July 31 to address payment concerns. CDCC expects participants to commit to the entire year and CDCC tuition is non-refundable. However, we understand extenuating circumstances may prohibit you from continued participation. Extenuating circumstances include a move out of the area, a death in the family and other life-altering situations. In these situation we will consider a refund on a caseby-case basis. Unexpected scheduling conflicts do not constitute an extenuating circumstance. For more information about tuition please see the green sheet titled Tuition Payment Schedule. 2

3 Payment Options: Tuition Payment Schedule Plan A: Pay full tuition by June 30, 2015 and receive an Early Bird Discount (see chart below). Plan B: Pay full tuition by July 31, If the full tuition is not paid by the due date a $30 late fee will be assessed. Plan C: Pay tuition in six monthly installments. You must go online and register for this plan through our website ( by July 31, This monthly payment plan is only offered through PayPal. Plan D: Will be requesting a tuition waiver. Written request due by June 12, More information on back side of this form. Tuition Amounts Early Bird Discount Jubilate Amount Due Date (if paid in full by June 30 th )* (3 rd & 4 th Grade) $220 July 31, 2015 $209* Bel Canto (5 th & 6 th Grade) $270 July 31, 2015 $257* Kantorei (7 th, 8 th & 9 th Grade) $310 July 31, 2015 $295* Angelica All Women s Choir $360 July 31, 2015 $342* Cantus Mixed High School $360 July 31, 2015 $342* Family Discount Families with two or more children in CDCC will receive a reduced rate. The oldest child will pay full tuition and subsequent children will pay half tuition for the choir they are in. Reduced tuition rates are as follows: Due on July 31, 2015 Discount (if paid in full by June 30 th )* Jubilate $110 $105* Bel Canto $135 $128* Kantorei $155 $147* Angelica $180 $171* Cantus $180 $171* Payment Methods We accept: Checks (payable to CDCC) Credit Cards (Visa, Mastercard & Discover) PayPal (create an account through our website: (Tuition waiver information on back) 3

4 Tuition waivers are based on the following: Tuition Waiver Information If your family receives assistance for lunch payment from the school your child attends, then you will be eligible for a 60% waiver for the year. We are asking that each family pay 40% of their child s tuition with payment due by July 31, If your family does not receive lunch assistance, but you are financially stressed, you may still be able to receive financial assistance. These requests will be decided on a case by case basis and will be followed up with a phone call to discuss your financial need. Requests for tuition waivers are due June 12, Tuition waiver forms are available upon request. Tuition waiver recipients will be expected to complete criteria set by the CDCC board of directors. You will be notified as to the status of your request prior to July 31,

5 Choir Commitment & Tuition Agreement * As a member of CDCC, I understand I would need to make singing in the choir a high priority and agree to be a member for the entire season. * As a member of Kantorei, Angelica or Cantus, I understand that I need to be a member of a school choir. * As a member of CDCC, I understand that I will have a one day a year school concert commitment for the season. * I agree to pay full tuition or set-up a payment plan by July 31, 2015 and understand that a late fee of $30 will be applied if tuition is not paid at that time. * I understand tuition is non-refundable. * I have read and understand the attendance policy and tuition policy. (Please see previous sheet.) Singer s Signature Parent s Signature Publicity Release I give permission to Central Dakota Children's Choir to use my child s name, image, and likeness for commercial or non-commercial purposes in photographic images for public display and for print or electronic distribution and dissemination. I hereby release and discharge Central Dakota Children's Choir from any and all claims and demands arising out of or in connection with CDCC s exercise of the rights granted herein. Parent s Signature Print Name Waiver and Release of Claims I recognize and acknowledge that there are certain risks of physical injury to participate in this program, and I agree to assume the full risk of any such injuries, damages, or loss regardless of severity which I or my child/ward may sustain as a result of participating in any activities connected or associated with this activity. I waive and relinquish all claims that I, my insurer, or my child/ward may have against the Central Dakota Children s Choir and its officers, agents, servants, and employees from any and all claims from injuries, damages, or loss which I or my child/ward may have or which may accrue to me or my child/ward on account of my participation or the participation of my child/ward in this program. I have read the above statements and agree to abide by them. Date / / Parent s Signature 5

6 New Uniforms One of the most important aspects of a group such as CDCC is appearance. Our choirs sound beautiful. Uniformity in dress enhances what we present to the community, state, and region. CDCC is pleased to announce that Bridal n More, located at 115 N. 4 th Street, will again be handling uniforms this year. They will give us a group rate of at least 25% off the listed price, which is what is shown below, up until the deadlines listed below. We ask that you mark and adhere to all deadlines listed on this note. After the deadline (June 12 for the long black dresses for Angelica and Cantus women and June 26 for everything else), the prices increase to the full cost as well as incurred shipping costs. Shipping costs can be very prohibitive. You don t want to miss the uniform deadline. When your child is done with their uniform, you have the opportunity to sell it on consignment. Jubilate Discounted Full Bel Canto Discounted Full Tuxedo Shirt $ $ Tuxedo Shirt $ $ Red Vest $ $ Black Palazzo Skirt $ $ Black Skirt $ $ Black Tux Pants $ $ Black Tux Pants $ $ Blue Vest $ $ Black Bow Tie $ 8.95 $ Black Bow Tie $ 8.95 $ Kantorei Discounted Full Cantus Discounted Full_ Black Dress $ $ Black Dress $ $ Tuxedo Shirt $ $ Tuxedo Shirt $ $ Black Tux Pants $ $ Black Tux Pants $ $ Black Vest $ $ Tuxedo Jacket $ $ Black Tie $ 8.95 $ Black Bow Tie $ 8.95 $ Angelica Discounted Full Black Dress $ $ Note About Uniform Sizing When participants order uniforms they should account for growth over the time that participant will be in that specific choir. All items are special ordered and all sales are final. Bridal N More does not allow returns or exchanges. If an item does not fit the participant because they grew, they must order and pay for an additional item. Bridal N More generally does not have any uniform items in stock except select tuxedo shirts and bow ties. Uniform Order Deadlines Angelica and Cantus women June 12 Jubilate, Bel Canto, Kantorei, and Cantus men June 26 Uniforms must be paid in full when ordered. Alterations Pants and skirts will arrive without final hems. Bridal N More is available to hem and alter garments for the prices listed below, though you can have them altered elsewhere if you wish. Please keep enough hem to allow for growth and resale! Hems - $20 Sizing - $20 6

7 Used Uniforms If you would like to sell your child s uniform on consignment, you may bring it to the choir office from May 26-June 2. Office hours are 11:00 a.m. 3:00 p.m. The choir office is located at the Frances Leach High Prairie Arts & Science Complex located at 1810 Schafer Street. (Note: The office will be closed Monday, May 25 for Memorial Day.) You will need to take the following steps in order for our office to accept your garments. 1. Launder all dresses, shirts, skirts, and pants. Any shirts with dirty cuffs or necks will not be accepted. 2. Label every garment submitted for sale (masking tape works). 3. Place dresses, shirts, skirts, pants, and vests on separate hangers. 4. Place bow ties in a zip lock bag with your name on it. A 15% processing fee will be deducted from the price of your sale with a minimum fee of $5. Garments not laundered will be assessed a $5 cleaning fee. Garments that do not sell, will be kept at the choir office and will be available for sale throughout the year. Payment for articles that sell during Used Uniform sale will be sent in October. Used garments will sell for the following prices: Jubilate Tuxedo Shirt $10 Skirt $20 Tuxedo Pants $25 Vest $30 Black Bow Tie $ 5 Bel Canto Tuxedo Shirt $10 Palazzo Skirt $30 Tuxedo Pants $25 Blue Vest $30 Black Bow Tie $ 5 Kantorei Dress $55 Tuxedo Shirt $10 Tuxedo Pants $25 Vest $30 Black Tie $ 5 You will be notified in late October in regard to garments that were or were not sold. Checks for used uniforms will be sent to you at that time. Sales begin at 7pm and are first-come, first-serve. You are welcome to come early to get a good place in line. June 3 June 4 Cantus, Angelica, Kantorei, and Bel Canto Jubilate Cantus Dress $70 Angelica Tuxedo Shirt $10 Dress - $70 Tuxedo Pants $25 Tuxedo Jacket $55 Black Tie $ 5 7

8 Student s Name Choir: (circle one) Jubilate Bel Canto Kantorei Angelica Cantus Informal Uniforms The informal uniform is a choir T-shirt and blue jeans for all the choirs. CDCC will provide shirts for the students. If they are in the same choir as last year, they should not need to get a new shirt unless they have grown a great deal. If they are changing from one choir to the next, we will provide a new T-shirt. When selecting a T-shirt size for your child, try to think large rather than small. Once they have received a T-shirt, it is not possible to exchange for a larger size. We have what we have. If we need to order additional T-shirts, there is a set up charge that needs to be paid in addition to the cost of the T-shirt. Check the T-shirt size that your child will need: Children s Sizes: _ Youth Medium (10-12) _ Youth Large (14-16) Adults Sizes: _ Adult Small _ Adult Medium _ Adult Large _ Adult X-Large _ Adult XX-Large _ I will not need a new shirt this year. (Singers who are in the same choir as last year and their shirt still fits.) Parent Volunteer Form As a nonprofit organization, Central Dakota Children s Choir depends heavily on volunteers. We also understand that your time is valuable and your commitments are many. Therefore, we do not expect you to volunteer for everything; however, we do ask that as a parent of a CDCC singer, you commit to volunteer at least once throughout the season. Whether the task is large or small, your gift of time will be greatly appreciated. Our most effective way of finding volunteers is through requests, so please keep your eye out for s from the office requesting volunteers. Please check any area where you may be able to help: Concert Help - usher, box office, handing out programs, photography, chaperone singers at concerts, etc. Equipment Help - help set up and tear down risers and other equipment Trailer Assistance - Transport choir trailer to performances. Must have a vehicle with a receiver for a hitch Baking Provide cookies or bars when needed (i.e. choir camp, High Prairie events, street fair, etc.) Fundraising/Special Event Help help with street fair booth, 4 th of July, Cantus Unabridged Other Event Help help with auditions, parent meeting, used uniform sale Choir Camp Help prep and distribute treats during summer choir camps. Singing in Style this is CDCC s annual banquet fundraiser. Areas in which we need help: Decorations _ Silent Auction _ Style Show _ Tickets/Help During Event Thank you for your gifts of time and talent. Without your help, we could not accomplish the many things we do!!! 8

9 Choir Communications Communication to CDCC choir families is very important. With 350 singers from 47 schools from central North Dakota, it is very important that we do everything to keep choir families informed about what is going on in CDCC. You will receive information via the following methods: Choir Binder Each child receives a binder at choir camp. All notes are 3-hole punched and ready for the binder. Students are asked to bring their binder to every rehearsal. Here are the types of information you might receive in the binder: Monthly Notes Calendars Forms Fundraising Information CDCC Hand Book The hand book will be available online at in August. In it you will find contact information for the choir office and music staff, information regarding rehearsals and attendance, and many other details that will be informative to you. is one of our best forms of communication with our choir families. We use them for reminders, for soliciting volunteers, for sending last minute information, and any other things that may come up at the last minute (i.e. blizzard warning, CDCC choirs have been cancelled.) Newsletter The CDCC newsletter, A Tempo is published three times a year and is sent to all the past and present choir families as well as choir sponsors and contributors. It has columns written by the artistic director, the executive director and each choir director. In addition, it has timely information about CDCC activities. Website If you have not checked out our website yet, we hope you will do so. Choir Notes/Forms Ticket Sales Calendar of Events Contributions Concert Information Information about Choir Events Facebook CDCC also maintains a page on Facebook. It is another way to stay informed about what s going on with CDCC. Please like us at Texting Parents will have the option of signing up for text reminders through Remind. Text messages will be reserved for important and last minute reminders/notices including rehearsal cancelations, ticket purchasing reminders, performances reminders, etc. 9

10 Choir Camp Jubilate 10:00 a.m. - 12:00 p.m. Bismarck State College Leach Music Center Choir Room Room 177 August 12-14, 2015 Bel Canto 9:00 a.m. - 12:00 p.m. Frances Leach High Prairie Arts & Science Complex Allegro Rehearsal Hall August 10-13, 2015 Kantorei 1:00 4:00 pm (Aug 22-23) 4:00-6:00 p.m. (Aug 24-25) Simle Middle School Choir Room August 22-25, 2015 Angelica 1:30 3:30 p.m. Bismarck State College Leach Music Center Choir Room Room 177 August 5-7, 2015 Cantus 6:30 9:30 p.m. (Aug 24-25) 6:30 8:30 p.m. (Aug 26) Frances Leach High Prairie Arts & Science Complex Allegro Rehearsal Hall August 24-26,

11 Regular Rehearsal Times Jubilate Tuesday 4:30 5:30 p.m. Bismarck State College Leach Music Center Choir Room Room 177 Starting Date: September 1, 2015 Bel Canto Monday and Thursday 5:15-6:00 p.m. High Prairie Arts & Science Complex Allegro Rehearsal Hall Starting Date: August 31, 2015 Kantorei Monday 5:30-7:00 p.m. Simle Middle School Choir Room Starting Date: August 31, 2015 Angelica Wednesday 4:15 5:45 pm Bismarck State College Leach Music Center Choir Room Room 177 Starting Date: September 2, 2015 Cantus Sunday 7:00 8:30 p.m. Legacy High School Choir Room Starting Date: August 30,

12 12

13 Demographic Survey Questions Tuition covers about 1/3 of our annual operating expenses. The rest comes from private donations and grants. Increasingly, grant applications ask for demographic information on our participant s families. Your cooperation in completing the following survey will help us greatly in qualifying for certain grant opportunities. Central Dakota Children s Choir respects your right to privacy. Completing this form is totally voluntary. It will have no bearing on your child s participation in CDCC. Household Composition: (please circle) Single Married Widowed Divorced Separated Other Number of children _ Ages of children Professional or Employment Status: Employed Self-employed Homemaker Student Military Retired Unable to work/unemployed Prefer not to answer Annual Household Income: Less than $15,000 $15,001-$25,000 $25,001-$35,000 $35,001-$45,000 $45,001-$55,000 $55,001-$75,000 $75,000 and above Prefer not to answer Ethnicity: (Please specify singer s ethnicity.) White Hispanic or Latino Black or African American Native American or American Indian Asian / Pacific Islander Other Prefer not to answer 13

Singers ONSTAGE! Registration Form

Singers ONSTAGE! Registration Form Singers ONSTAGE! Registration Form Student Information Full Name City State Zip Home Phone Date of Birth Grade (as of 9/1/15) Gender (circle one): Male Female Each registration includes two T-shirts, professional

More information

BJHS Band Contract Winds and Percussion

BJHS Band Contract Winds and Percussion 2017-2018 BJHS Band Contract Winds and Percussion The band program consists of both fall and spring ensembles. Fall ensembles include football marching, competition marching, and jazz band. Spring band

More information

BJHS Band Contract Winds and Percussion

BJHS Band Contract Winds and Percussion 2018-2019 BJHS Band Contract Winds and Percussion The band program consists of both fall and spring ensembles. Fall ensembles include football marching, competition marching, and jazz band. Spring band

More information

BUSINESS EXPO TUESDAY SEPTEMBER 11, :00-7:00 PM RICHLAND CREEK COMMUNITY CHURCH, 3229 BURLINGTON MILLS RD., WAKE FOREST BOOTH SPACE

BUSINESS EXPO TUESDAY SEPTEMBER 11, :00-7:00 PM RICHLAND CREEK COMMUNITY CHURCH, 3229 BURLINGTON MILLS RD., WAKE FOREST BOOTH SPACE TUESDAY SEPTEMBER 11, 2018 3:00-7:00 PM RICHLAND CREEK COMMUNITY CHURCH, 3229 BURLINGTON MILLS RD., WAKE FOREST The Chamber s annual Business Expo provides both small and large businesses with the best

More information

APPLICATION

APPLICATION MAYOR THOMAS C. HENRY CITY OF FORT WAYNE MAYOR S YOUTH ENGAGEMENT COUNCIL 2017-2018 APPLICATION Please mail, deliver or fax completed applications to: MAYOR S OFFICE, ATTN: KAREN L. RICHARDS 200 E. BERRY

More information

BAY STATE GAMES MARATHON FUNDRAISING TEAM APPLICATION

BAY STATE GAMES MARATHON FUNDRAISING TEAM APPLICATION Bay State Games is proud to be a member of the John Hancock Non-Profit Marathon Program BAY STATE GAMES MARATHON FUNDRAISING TEAM APPLICATION The Massachusetts Amateur Sports Foundation / Bay State Games,

More information

BAY STATE GAMES MARATHON FUNDRAISING TEAM APPLICATION

BAY STATE GAMES MARATHON FUNDRAISING TEAM APPLICATION BAY STATE GAMES MARATHON FUNDRAISING TEAM APPLICATION The Massachusetts Amateur Sports Foundation / Bay State Games, is offering the opportunity to participate as an official entrant in the 2018 Boston

More information

REGISTRATION ON PACKET

REGISTRATION ON PACKET This Packet Contains The Following Forms: 2018-19 REGISTRATION ON PACKET 1. First Payment and Intent to Attend Band Camp form - due May 11, 2018 2. Seminole County Medical & Travel form (this form must

More information

Registration Forms & Important Information

Registration Forms & Important Information Registration Forms & Important Information 2016 2017 Fill out pages 1-5 and keep 6-9. Please return by May 28, 2016. 2010 & 2011 SCBDA 4A State Champions! Student Nickname: Male [ ] Female [ ] Address:

More information

Description. The Color Guard Deposit is Non-Refundable

Description. The Color Guard Deposit is Non-Refundable Lanier Longhorns Marching Band Financial Policy for New Members Color Guard For your convenience you can make payments to the Lanier Band Booster Association using any of the options below: g Payment Due

More information

Summer Day Camp Registration 2018 Pierce County School Based Day Camps YMCA OF PIERCE AND KITSAP COUNTIES

Summer Day Camp Registration 2018 Pierce County School Based Day Camps YMCA OF PIERCE AND KITSAP COUNTIES Summer Day Camp Registration 2018 Pierce County School Based Day Camps YMCA OF PIERCE AND KITSAP COUNTIES Completed registration is due the Wednesday prior to first day of camp. Return registration to

More information

Santa Margarita Catholic High School Girl s Soccer

Santa Margarita Catholic High School Girl s Soccer Welcome Eagles! This booklet contains all of the information and approval forms that must be completed, signed, and returned by the parents of all players before the player will receive their uniform and

More information

2017 ANNUAL CONFERENCE

2017 ANNUAL CONFERENCE BEYOND THE HORIZON S 2017 ANNUAL CONFERENCE EXHIBITING AT THE 2017 ANNUAL CONFERENCE WALT DISNEY WORLD SWAN AND DOLPHIN RESORT ORLANDO, FLORIDA DEC. 2 6, 2017 #LEARNFWD17 www.learningforward.org/conference

More information

U.S. Martial Arts Academy SUMMER CAMP 2015

U.S. Martial Arts Academy SUMMER CAMP 2015 U.S. Martial Arts Academy SUMMER CAMP 2015 3430 Oak Road Vineland, NJ 08361 Hours of operation 7:30am-5:30pm (Monday-Friday) Dates of Operation: Monday June 22nd thru Friday August 28th CLOSED WEEK OF

More information

2017 SPONSORSHIP CATALOG

2017 SPONSORSHIP CATALOG 2017 SPONSORSHIP CATALOG AORE Dear AORE Supporter, Thanks for trusting the Association of Outdoor Recreation and Education (AORE) as a partner in your marketing and sales efforts in the outdoor recreation

More information

2017 VolunTEEN Scheduling Form. SHIRT SIZE: S M L XL XXL **sizes run big

2017 VolunTEEN Scheduling Form. SHIRT SIZE: S M L XL XXL **sizes run big 2017 VolunTEEN Scheduling Form NAME: PHONE #: SHIRT SIZE: S M L XL XXL **sizes run big Indicate below your preference of shift by numbering the blocks by 1 st, 2 nd and 3 rd choice. If you have two first

More information

2015 GISA All-Select Middle School Honor Chorus

2015 GISA All-Select Middle School Honor Chorus 2015 GISA All-Select Middle School Honor Chorus Schedule and Information Packet DATES: Friday, February 6, 2015 & Saturday, February 7, 2015 (See Schedule Below) LOCATION: King s Ridge Christian School

More information

Application for Admission

Application for Admission Application for Admission Personal Care Skilled Nursing Short-term Rehabilitation Respite Stays Hospice Care Please Return to the Admissions Office: MaryAnn McLaughlin Director of Admissions Phone: (215)

More information

Student T-shirt size is: Small Medium Large XLarge 2XLarge 3XLarge (Circle one)

Student T-shirt size is: Small Medium Large XLarge 2XLarge 3XLarge (Circle one) Participant Permission Form/ Release Waiver Form My child,, has my permission to attend. I understand this celebration is offered to all graduates who have signed and maintained both the Project Grad Participant

More information

1) INFORMATION ABOUT THE PARTICIPANT AND ACTIVITY

1) INFORMATION ABOUT THE PARTICIPANT AND ACTIVITY 2016-17 South Carolina 4-H Membership and Event Permission Form for Youth (Updated 08.01.16) ALL elements of this form must be completed by youth participating in clubs, field trips, events requiring group

More information

2018 SUMMER CAMP NANSEMA REGISTRATION NORTH SUBURBAN YMCA

2018 SUMMER CAMP NANSEMA REGISTRATION NORTH SUBURBAN YMCA 2018 SUMMER CAMP NANSEMA REGISTRATION NORTH SUBURBAN YMCA CONTACT INFORMATION Camper s Name: Grade entering Fall 2018: Gender: Female Male Not specified DOB: Age as of 1st day of camp: Address: City: Zip

More information

CAMP AT THE EASTWARD A Youth Ministry of Mission at the Eastward

CAMP AT THE EASTWARD A Youth Ministry of Mission at the Eastward CAMP AT THE EASTWARD A Youth Ministry of Mission at the Eastward Dear Camper and Family, We are welcoming some changes to the camp schedule this year! In an effort to allow our dedicated work groups to

More information

Summer Camp Registration Form

Summer Camp Registration Form SUBMIT AGREEMENT PAYMENT CAMP DETAILS MEMBERSHIP PARTICIPANT INFO INSTRUCTIONS Be sure to read event registration details before registering. Please print clearly with blue/black ink or type. Forms cannot

More information

Location of Recordings Indiana University Date(s) of Recordings. Name of the Program: Percussion Academy. Participant s Signature Date / /

Location of Recordings Indiana University Date(s) of Recordings. Name of the Program: Percussion Academy. Participant s Signature Date / / I ( Participant ) authorize The Trustees of Indiana University ( IU ), acting through its agents, employees, or representatives, to take photographs, video recordings, and/or audio recordings of me, including

More information

NOT SIGNED/INCLUDED as my student does not self-administer medicine

NOT SIGNED/INCLUDED as my student does not self-administer medicine 2017-18 School Year Hello, and welcome to Ridge Point High School Band and Guard! The attached forms help us manage and support the more than 170 members of the Band and Guard. Please sign and return all

More information

Thank you for choosing Oakland Medical Center as your Patient-Centered Medical Home

Thank you for choosing Oakland Medical Center as your Patient-Centered Medical Home Thank you for choosing Oakland Medical Center as your Patient-Centered Medical Home We ask that you complete the enclosed paperwork and bring it with you at the time of your appointment. We also ask that

More information

OUR CHILDREN ARE OUR FUTURE!

OUR CHILDREN ARE OUR FUTURE! OUR CHILDREN ARE OUR FUTURE! ANISHINABE PERFORMANCE CIRCLE - SPRING 2016 YOUTH AND ADULT CLASSES AVAILABLE SIGN UP NOW! FIRST CLASS FEBRUARY 2, 2016 For more information/register: Contact Raymond Cadotte

More information

2014 BAY STATE GAMES MARATHON TEAM

2014 BAY STATE GAMES MARATHON TEAM 2014 BAY STATE GAMES MARATHON TEAM The Massachusetts Amateur Sports Foundation / Bay State Games, is offering the opportunity to participate as an official entrant in the 2014 Boston Marathon to be held

More information

VETERINARY & BIOMEDICAL SCIENCES SUMMER CAMP-2018 REGISTRATION FORM

VETERINARY & BIOMEDICAL SCIENCES SUMMER CAMP-2018 REGISTRATION FORM 1 VETERINARY & BIOMEDICAL SCIENCES SUMMER CAMP-2018 REGISTRATION FORM When: Residential camp: June 24 (Sunday)-June 29 (Friday), 2018 Commuters: June 25 (Monday)-June 29, 2018 In order to get personal

More information

Interlake High School Band Handbook

Interlake High School Band Handbook Interlake High School 2018 2019 Band Handbook 1. Bands Overview 2. Student Expectations 3. Uniform and Concert Attire, Policies 4. Class Fees and BSD Instrument Rental Policies 5. Events 6. Interlake Music

More information

Brighton High School Band Information

Brighton High School Band Information 2016-2017 Brighton High School Band Information MEMBERSHIP: All Incoming/New members outside of the Brighton Middle & High School Bands program must audition for placement within the Brighton High School

More information

Pottstown Parks & Recreation Summer Adventure Registration

Pottstown Parks & Recreation Summer Adventure Registration Pottstown Parks & Recreation Summer Adventure Registration Please complete ALL information; registration will not be processed without ALL information. Please note, your enrollment is not guaranteed NOR

More information

Invitation to Exhibit or Sponsor. Pennsylvania Decentralized Wastewater Conference and Trade Show. January 29-30, 2018

Invitation to Exhibit or Sponsor. Pennsylvania Decentralized Wastewater Conference and Trade Show. January 29-30, 2018 Invitation to Exhibit or Sponsor Pennsylvania Decentralized Wastewater Conference and Trade Show January 29-30, 2018 Red Lion Hotel 4751 Lindle Road, Harrisburg PA Brought to you by: Don t miss the 2018

More information

BANGOR REGION YMCA CHILDCARE REGISTRATION FORM

BANGOR REGION YMCA CHILDCARE REGISTRATION FORM On-Site Registration Required BANGOR REGION YMCA CHILDCARE REGISTRATION FORM Childcare Information & Program Attending - Please Print ( )Early Childhood Education ( )Y-Works ( )Before School ( )After School

More information

BUSINESS EXPO TUESDAY SEPTEMBER 19, :00-7:00 PM RICHLAND CREEK COMMUNITY CHURCH, 3229 BURLINGTON MILLS RD., WAKE FOREST BOOTH SPACE

BUSINESS EXPO TUESDAY SEPTEMBER 19, :00-7:00 PM RICHLAND CREEK COMMUNITY CHURCH, 3229 BURLINGTON MILLS RD., WAKE FOREST BOOTH SPACE TUESDAY SEPTEMBER 19, 2017 3:00-7:00 PM RICHLAND CREEK COMMUNITY CHURCH, 3229 BURLINGTON MILLS RD., WAKE FOREST The Chamber s annual Business Expo provides both small and large businesses with the best

More information

H Alumni Camp Application

H Alumni Camp Application 2018 4-H Alumni Camp Application Due May 18, 2018 Camp Registration $75 Make checks payable to Boone County 4-H Sr. Council Name County of Alumni Membership Age Date of Birth Male Female Address City State/Zip

More information

Woodland High School Wildcat Bands 800 Old Alabama Road Cartersville, GA

Woodland High School Wildcat Bands 800 Old Alabama Road Cartersville, GA Woodland High School Wildcat Bands 800 Old Alabama Road Cartersville, GA 30120 www.woodlandband.org Dear Color Guard Members and Parents: April 15, 2016 WELCOME to the Woodland High School Band program!!

More information

Student Name: Home Address: Street. City State Zip County of Residence. Student HS Graduation Year: Name of High School: GPA:

Student Name: Home Address: Street. City State Zip County of Residence. Student   HS Graduation Year: Name of High School: GPA: Page 1 of 8 Participant Application SCRUBS CAMP: Hands on Adventures in Health-Care 3 Day Summer Camp (9am - 4pm) Tuesday, June 12 th Thursday June 14 th, 2018 OR Tuesday, July 17 th - Thursday, July 19

More information

Watermarks MS/HS Camp Information

Watermarks MS/HS Camp Information Watermarks MS/HS Camp Information When: Friday, November 13 - Sunday, November 15 Where: Watermarks Camp in Scottsville, VA (just south of Charlottesville) Cost: $110 Register by November 2. We will leave

More information

Project Aerospace ACE Academy Application

Project Aerospace ACE Academy Application Project Aerospace ACE Academy Application Location: (s): The OBAP Aviation Career Education (ACE) Academy is designed to provide a more in-depth look at the aviation industry for students who truly want

More information

Cooperative Extension Service Daviess County 4800A New Hartford Road Owensboro KY Fax: extension.ca.uky.

Cooperative Extension Service Daviess County 4800A New Hartford Road Owensboro KY Fax: extension.ca.uky. Cooperative Extension Service Daviess County 4800A New Hartford Road Owensboro KY 42303 270-685-8480 Fax: 270-685-3276 extension.ca.uky.edu Win A Chicken Coop! Girls In Agriculture Leadership Academy

More information

Frank Augustus Miller Middle School. Color Guard Team

Frank Augustus Miller Middle School. Color Guard Team Frank Augustus Miller Middle School Color Guard Team 2017 2018 Frank A. Miller Middle School Color Guard 17925 Krameria Ave. Riverside CA 92504 (951) 789-8181 Beth Salyers Color Guard Advisor Dear Parents,

More information

APPLICATION. Name (Last, First, MI): Address: City, State, & Zip Code: Home Telephone: Cell Telephone: Date of Birth: / /

APPLICATION. Name (Last, First, MI): Address: City, State, & Zip Code: Home Telephone: Cell Telephone: Date of Birth: / / Girls in Engineering Academy (GEA) July 10 August 4, 2017 APPLICATION A Summer Pre-Engineering Program for Middle School Girls Please print or type all information. Additional sheets may be attached if

More information

If there is any home custody issues (i.e. divorce, restraining orders, etc.), it is imperative that we are made aware.

If there is any home custody issues (i.e. divorce, restraining orders, etc.), it is imperative that we are made aware. June 1, 2016 Dear Parents: Welcome to the New Lenox Community Park District ACES Program! We are very excited to be able to be the sole provider for District #122 with our quality before and after school

More information

Assumption of the BVM/Immaculate Conception Family Faith Formation Tuition Rates & Information

Assumption of the BVM/Immaculate Conception Family Faith Formation Tuition Rates & Information Assumption of the BVM/Immaculate Conception Family Faith Formation Tuition Rates & Information 2017 2018 Family Name: IMPORTANT: Please provide your current e-mail address, as this is our method of communicating

More information

117th B.A.A. Boston Marathon - April 15, Applications will be reviewed on a rolling basis until all Team Red Cross bibs have been assigned.

117th B.A.A. Boston Marathon - April 15, Applications will be reviewed on a rolling basis until all Team Red Cross bibs have been assigned. 117th B.A.A. Boston Marathon - April 15, 2013 Applications will be reviewed on a rolling basis until all Team Red Cross bibs have been assigned. Team Red Cross is an official charity team for the 117th

More information

Arkansas 4 H Activity Application For Youth Leadership Roles

Arkansas 4 H Activity Application For Youth Leadership Roles Arkansas 4 H Activity Application For Youth Leadership Roles 1 FY4-H-657 01/10/2017 Name County Read Carefully. This application should be filled out in detail. Please print or type.contact your local

More information

Multifaceted COSHRM OUT OF THE ORDINARY INTO THE EXTRAORDINARY. State Conference EXHIBITOR PROSPECTUS. September 27 29, 2017 Keystone CO PRESENTED BY

Multifaceted COSHRM OUT OF THE ORDINARY INTO THE EXTRAORDINARY. State Conference EXHIBITOR PROSPECTUS. September 27 29, 2017 Keystone CO PRESENTED BY Multifaceted HR OUT OF THE ORDINARY INTO THE EXTRAORDINARY EXHIBITOR PROSPECTUS PRESENTED BY COSHRM 2017 State Conference September 27 29, 2017 Keystone CO Expect something Welcome to the COSHRM 2017 State

More information

Georgetown Police Department 2018 Junior Police Academy Application

Georgetown Police Department 2018 Junior Police Academy Application Georgetown Police Department Application Application Deadline: Friday, April 27, 2018 by 5:00pm. There are 25 slots available for each camp, so don t delay in turning in your application. Applications

More information

MAHC Has Your Recipe for Success!

MAHC Has Your Recipe for Success! The Missouri Alliance for Home Care presents 2015 Annual Conference and Home Care Exhibition Exhibitor Prospectus MAHC Has Your Recipe for Success! What You Need to Know The Missouri Alliance for Home

More information

Community Life Center

Community Life Center Community Life Center- 2018-2019 Page 2 of 6 MEGA SPORTS CAMP- Waiver & Release Forms Effective Dates: January 1, 2018 January 1, 2019 CHILD S INFORMATION Name Grade Age DOB Male/Female Nickname School:

More information

VOLUNTEER WITH US. 332 Stable Lane Wentzville MO Phone (636) Fax (636)

VOLUNTEER WITH US. 332 Stable Lane Wentzville MO Phone (636) Fax (636) VOLUNTEER WITH US 332 Stable Lane Wentzville MO 63385 Phone (636) 332-4940 Fax (636) 332-4941 WWW.THSTL.ORG Dear Prospective Volunteer, TREE House of Greater St. Louis (TH) is one of the nation s oldest

More information

MCMCFC. Believe & Succeed! In order to succeed, we must first believe that we can. - Nikos Kazantzakis

MCMCFC. Believe & Succeed! In order to succeed, we must first believe that we can. - Nikos Kazantzakis 2 0 1 8 MCMCFC Spring Management Conference In order to succeed, we must first believe that we can. - Nikos Kazantzakis EXHIBITOR PACKET You are invited to exhibit! Welcome! The Michigan County Medical

More information

CALVERT COUNTY DIVISION OF PARKS AND RECREATION APPLICATION FOR USAGE OF COMMUNITY CENTER FACILITIES

CALVERT COUNTY DIVISION OF PARKS AND RECREATION APPLICATION FOR USAGE OF COMMUNITY CENTER FACILITIES CALVERT COUNTY DIVISION OF PARKS AND RECREATION APPLICATION FOR USAGE OF COMMUNITY CENTER FACILITIES ALL APPLICATIONS PENDING UPON APPROVAL CENTER REQUESTED: Southern Community Center, 20 Appeal Lane,

More information

2014 MASH CAMP. June 9-12 Basic (15 student limit) Grades 9-12 June Advanced (15 student limit) Juniors/Seniors ONLY

2014 MASH CAMP. June 9-12 Basic (15 student limit) Grades 9-12 June Advanced (15 student limit) Juniors/Seniors ONLY MEDICAL CAMP 2014 MASH CAMP Medical Avenues to Services in Health (M*A*S*H) programs are designed to educate High School students about the possibility of pursuing a career in the health service field

More information

REGISTRATION FORM (Minors)

REGISTRATION FORM (Minors) LEGAL NAME REGISTRATION FORM (Minors) Social Security#: Date of Birth: Sex: M or F Nickname: Religion: Church: Race (circle one): White Black-Asian AM Indian Alaska Native Native Hawaiian Pacific Islander-Unknown

More information

EXHIBITOR APPLICATION 26th Annual Bridal Expo

EXHIBITOR APPLICATION 26th Annual Bridal Expo EXHIBITOR APPLICATION 26th Annual Bridal Expo presented by The Gainesville Civic Center Sunday, January 14, 2018 12:30pm-4:00pm Fashion Show at 2:30pm HELP THEM FIND THEIR HAPPILY EVER AFTER Exhibitor

More information

NEW PATIENT PACKET. Address: City: State: Zip: Home Phone: Cell Phone: Primary Contact: Home Phone Cell Phone. Address: Driver s License #:

NEW PATIENT PACKET. Address: City: State: Zip: Home Phone: Cell Phone: Primary Contact: Home Phone Cell Phone.  Address: Driver s License #: Patient s Name: NEW PATIENT PACKET Last Middle First Address: City: State: Zip: Home Phone: Cell Phone: Primary Contact: Home Phone Cell Phone Email Address: Driver s License #: DOB: Gender: Male Female

More information

Junior/Teen Volunteer Program

Junior/Teen Volunteer Program Junior/Teen Volunteer Program Dear Prospective Junior/Teen Volunteer: Enclosed you will find information and forms to complete to become a Junior/Teen Volunteer. The Junior/Teen Volunteer Program is a

More information

2011 Summer Internship Application

2011 Summer Internship Application 2011 Summer Internship Application Teen Career Connection is an eight-week professional internship program. Following intensive preparation, participants complete a 5-week paid summer internship at a New

More information

The Grayson High School Band Department. Announces. Tryouts for the Color Guard. 6:30 8:30 pm. GHS Band Room

The Grayson High School Band Department. Announces. Tryouts for the Color Guard. 6:30 8:30 pm. GHS Band Room The Grayson High School Band Department Announces Tryouts for the 2013-2014 Dates: Training Sessions (New Members) April 18 & 25, 2013 6:30 8:00 Tryouts New & Veteran Members) April 29, 30 & May 2, 2013

More information

Ventura High School Music Boosters PO Box 3051, VENTURA, CA FEIN:

Ventura High School Music Boosters PO Box 3051, VENTURA, CA FEIN: August 21, 2018 Dear Ventura High School Music Families: Welcome to the Ventura High School and the 2018/19 school year! The Boosters group is an all-volunteer, non-profit organization that serves to support

More information

WELCOME!!! IE, GYB! Apopka Band & Guard!

WELCOME!!! IE, GYB! Apopka Band & Guard! WELCOME!!! IE, GYB! Apopka Band & Guard! A PLACE TO CALL HOME IE, GYB! PHILOSOPHY PROGRAM MAKE UP Wind Bands Concert Band (Freshmen) Split Classes (WW/BR) Symphonic Band Wind Symphony Percussion Ensemble

More information

2018 Safety Coloring Page Contest

2018 Safety Coloring Page Contest 2018 Safety Coloring Page Contest Coloring Page Guidelines 1. The Safety Coloring Page Contest is open to any youth ages 4 to 6 years old. The contest is not limited to children or grandchildren of Farm

More information

SERVICE ORGANIZATIONS, CHURCHES AND NOT-FOR-PROFIT ORGANIZATIONS APPLICATION AND INFORMATION

SERVICE ORGANIZATIONS, CHURCHES AND NOT-FOR-PROFIT ORGANIZATIONS APPLICATION AND INFORMATION 500 N Main Street (P. O. Box 66) Danbury, North Carolina 27021 SERVICE ORGANIZATIONS, CHURCHES AND NOT-FOR-PROFIT ORGANIZATIONS APPLICATION AND INFORMATION September 8th and September 9th, 2018 Hours:

More information

Volunteer Application

Volunteer Application Volunteer Application I. CONTACT INFORMATION Mr. Mrs. Name (first): (middle): (last): Ms. Home Address: City: State: Zip: Phone (home): E-mail Address: (business): (cell): Birth Date: Employer/School:

More information

June 10-13, 2018, Washington, D.C.

June 10-13, 2018, Washington, D.C. 1 June 10-13, 2018, Washington, D.C. The NCA Leadership Conference is an annual event forum offering a range of educational, networking and business opportunities for Children s Advocacy Center (CAC) leaders

More information

76TH ANNUAL CONFERENCE SEATTLE, WASHINGTON ~ JULY 14-17, 2013 THE WESTIN SEATTLE HOTEL

76TH ANNUAL CONFERENCE SEATTLE, WASHINGTON ~ JULY 14-17, 2013 THE WESTIN SEATTLE HOTEL 76TH ANNUAL CONFERENCE THE EXHIBITOR & SPONSOR SALES KIT CONFERENCE INFORMATION AND DEMOGRAPHICS: We invite you to join us in Seattle for the National Council of Juvenile and Family Court Judges 76th Annual

More information

Dear Zoo Crew Applicant,

Dear Zoo Crew Applicant, Dear Zoo Crew Applicant, Thank you for your interest in Zoo Crew, the Children s Zoo teen volunteer program! For a complete list of program benefits visit our website at www.saginawzoo.com. Please read

More information

CYO Emerald Knights Summer Marching Band and Guard 2018 Season Information

CYO Emerald Knights Summer Marching Band and Guard 2018 Season Information CYO Emerald Knights Summer Marching Band and Guard 2018 Season Information It s time to prepare for another summer of marching and fun with the CYO Emerald Knights Marching Band and Guard of Kenosha! Overview

More information

2018 DETROIT GRAND PRIX ASSOCIATION Renewal Membership Application

2018 DETROIT GRAND PRIX ASSOCIATION Renewal Membership Application 2018 DETROIT GRAND PRIX ASSOCIATION Renewal Membership Application Do not send payment without completed application. All DGPA members must be at least 18 yrs of age or 16 yrs old if accompanied by adult

More information

A Total Commitment is Required Including Attending All Practices and Games

A Total Commitment is Required Including Attending All Practices and Games DANCE TEAM AUDITION INFORMATION A Total Commitment is Required Including Attending All Practices and Games WHEN: Saturday, August 26 9 a.m. 3 p.m. WHERE: Aspen Athletic Club 61 st & S. Memorial Dr. Tulsa,

More information

Peoria PlayHouse Children s Museum Volunteer Application

Peoria PlayHouse Children s Museum Volunteer Application Peoria PlayHouse Children s Museum Volunteer Application Thank you for your interest in volunteering at the PlayHouse Children s Museum! Volunteers play a vital role in the success of our museum and we

More information

2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION

2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION 2018 MARSHALL COUNTY LAW ENFORCEMENT YOUTH CAMP APPLICATION Law Enforcement agencies from across Marshall County will sponsor and provide a Law Enforcement Youth Camp for students this year on the dates

More information

MESA Summer Academy: Solar System Mission Possible Application Deadline: June 1, 2018 Early Bird Discount Deadline: May 1, 2018

MESA Summer Academy: Solar System Mission Possible Application Deadline: June 1, 2018 Early Bird Discount Deadline: May 1, 2018 MESA Summer Academy: Solar System Mission Possible Application Deadline: June 1, 2018 Early Bird Discount Deadline: May 1, 2018 Program Description Get a head start on your career in space exploration

More information

Voices of Naples Inc.

Voices of Naples Inc. Voices of Naples Inc. General Information Contact Information Nonprofit Primary Contact First Name Primary Contact Last Name Voices of Naples Inc. Jan Huffman Address 263 9th Ave. S. Naples, FL 34102 Phone

More information

The Request for Proposal must be completed and submitted to CANAAF for its review and approval

The Request for Proposal must be completed and submitted to CANAAF for its review and approval February 21, 2017 Dear Event Coordinator, On behalf of the Board of Directors of the CANAAF, we thank you for your support of our fundraising efforts. CANAAF s mandate is CANAAF supports those affected

More information

Savannah State University. Middle School And High School Summer Band Camp. June 19-25, Savannah State University Campus

Savannah State University. Middle School And High School Summer Band Camp. June 19-25, Savannah State University Campus Savannah State University Middle School And High School Summer Band Camp June 19-25, 2011 Savannah State University Campus The premiere Marching band of Georgia, Savannah State University Coastal Empire

More information

Third Party Event Manual

Third Party Event Manual Third Party Event Manual Table of Contents Purpose of this Manual...2 Event Ideas List... 3 Third Party Event Agreement... 4 Resources from Us...... 9 Promoting your Event....10 Event Planning Checklist...

More information

Donation Drive Planning Kit

Donation Drive Planning Kit Donation Drive Planning Kit Are you interested in coordinating your own donation drive to raise financial donations or in-kind items for The Centers for Families and Children? This tool kit will provide

More information

FOREST PARK MARCHING BRUIN BAND

FOREST PARK MARCHING BRUIN BAND FOREST PARK MARCHING BRUIN BAND 2017 HANDBOOK Mr. Rob Specketer, Director SpeckeRC@pwcs.edu www.bruinband.net @FPHSBruinBand Greetings Students and Parents! Welcome to the 2017 season of the Marching Bruin

More information

August 19-24, 2014 (Tuesday-Sunday)

August 19-24, 2014 (Tuesday-Sunday) What is EDGE Adventure Camp? A five day Catholic camp with sports & activities including canoeing, kayaking, giant rope swing, water sports and more! Live music, catechesis, Mass, praise & worship and

More information

CALL FOR ART VENDORS

CALL FOR ART VENDORS CALL FOR ART VENDORS SELL YOUR WORK AT CHALK THE BLOCK 10! Art Vendors are invited to participate in the 10th Annual Chalk the Block Public Arts Festival for vending opportunities on October 7 and 8. THE

More information

Schedule of Classes Monday. Tuesday. Wednesday. Thursday. Friday. Saturday

Schedule of Classes Monday. Tuesday. Wednesday. Thursday. Friday. Saturday Schedule of Classes 2018-19 Studio 1 2 111 Harvard Place Studio 149 W. First Street 3:30 4:30 Primary Exam DD 4:30 5:30 Grade 1 Ballet DD 5:30 6:30 Intermediate Ballet DD 6:30 7:30 Grade 7 Ballet DD 3:30

More information

CAMPER S NAME: DATE OF BIRTH: AGE: ADDRESS: CITY: STATE: ZIP: SCHOOL: GRADE: 2018 KROC SUMMER CAMPS

CAMPER S NAME: DATE OF BIRTH: AGE: ADDRESS: CITY: STATE: ZIP:   SCHOOL: GRADE: 2018 KROC SUMMER CAMPS Please complete one (1) per child. CONTACT INFORMATION CAMPER S NAME: DATE OF BIRTH: AGE: PARENT (GUARDIAN) NAME: CAMPER LIVES WITH (CUSTODIAL PARENT): PHONE: DAY CELL ALTERNATE ADDRESS: CITY: STATE: ZIP:

More information

Applicant must have taken the ACT/SAT Test at least once and submit their scores.

Applicant must have taken the ACT/SAT Test at least once and submit their scores. HENDERSON STATE UNIVERSITY SUMMER INSTITUTE STUDENT INFORMATION SHEET Sunday, July 8-Thursday, July 12, 2018 Application deadline for ALL applications is Friday, June 4, 2018 ELIGIBILITY CRITERIA Applicant

More information

Money-Earning Application Packet

Money-Earning Application Packet Money-Earning Application Packet Girl Scout activities should be funded primarily by money earned through GSCB sponsored Product Programs and any dues collected. However, if the budget goal for a specific

More information

ICM Food & Clothing Bank Volunteer Application

ICM Food & Clothing Bank Volunteer Application Please print legibly. Date: / _/ ICM Food & Clothing Bank Volunteer Application Name: Email: Tel: ( ) Cell: ( ) Address: City: State: Zip: Emergency Contact Tel: 1. How did you hear about ICM? (i.e., school,

More information

March 3, Dear Team Captain,

March 3, Dear Team Captain, March 3, 2008 Dear Team Captain, Welcome to the 17 th annual 24 Hour Relay Challenge scheduled for Memorial Day weekend, May 24-25, 2008, on Holt Field at San Luis Obispo High School. This packet is intended

More information

NAPERVILLE SENIOR CENTER MEMBER INFORMATION

NAPERVILLE SENIOR CENTER MEMBER INFORMATION NAPERVILLE SENIOR CENTER MEMBER INFORMATION Member Name: Address: City: SSN: Long Term Insurance: DOB: Home Phone: Cell Phone: Zip: Email Address: Other Entitlement (specify): Living Arrangement: Alone

More information

North Carolina Extension Master Gardener Volunteer Application Guilford County

North Carolina Extension Master Gardener Volunteer Application Guilford County North Carolina Extension Master Gardener Volunteer Application Guilford County Please return all seven (7) pages of the completed Application to: 3309 Burlington Rd, Greensboro, NC 27405 GENERAL INFORMATION

More information

W e l c o m e t o B i l l e r i c a C h i r o p r a c t i c

W e l c o m e t o B i l l e r i c a C h i r o p r a c t i c W e l c o m e t o B i l l e r i c a C h i r o p r a c t i c N E W P A T I E N T I N T A K E F O R M Print Name Today s Date Address City State Zip Email Address Date of Birth Male Female Social Security

More information

North Carolina Extension Master Gardener Volunteer Application Caldwell County

North Carolina Extension Master Gardener Volunteer Application Caldwell County North Carolina Extension Master Gardener Volunteer Application Caldwell County Please return all five (5) pages of the completed Application and payment to: Caldwell CES 120 Hospital Ave, NE Suite 1 Lenoir

More information

General Information & Preparation

General Information & Preparation Ponderosa Retreat Parent Information Please Keep This Information Paper for your Reference All Other Forms, with $50 Payment, Turn-in by Friday, August 17 All Other Forms Must be Signed to be Valid General

More information

St. Mary School A Place of Spirited Learning January 12, 2015

St. Mary School A Place of Spirited Learning January 12, 2015 St. Mary School A Place of Spirited Learning January 12, 2015 Monday, January 12, 2015 Tuesday, January 13, 2015 Wednesday, January14, 2015 Thursday, January 15, 2015 Friday, January 16, 2015 Monday, January

More information

Hosting a Fundraiser. #KeepingFamiliesClose

Hosting a Fundraiser. #KeepingFamiliesClose 501 E. Roanoke Avenue Phoenix, AZ 85004 Phone 602-798-5097 Fax 602-264-5670 events@rmhcphoenix.com www.rmhcphoenix.com Hosting a Fundraiser Thank you for your interest in hosting a fundraiser for Ronald

More information

Prattville High School Band The Pride of Prattville

Prattville High School Band The Pride of Prattville Prattville High School Band The Pride of Prattville General Info and F.A.Q. For over seventy years, the Pride of Prattville Band has demonstrated excellence in performance all over the South and the entire

More information

Keene Family YMCA CAMP REGISTRATION PACKET 2018

Keene Family YMCA CAMP REGISTRATION PACKET 2018 Keene Family YMCA CAMP REGISTRATION PACKET 2018 ONE PACKET PER CHILD. Please complete all pages of this registration packet. It is important that you fill out every field and provide complete contact information

More information

Tuesday. Newsletter. Sacred Heart of Jesus School is a diverse community dedicated to educating the body, mind and spirit.

Tuesday. Newsletter. Sacred Heart of Jesus School is a diverse community dedicated to educating the body, mind and spirit. Tuesday The Newsletter Sacred Heart of Jesus School is a diverse community dedicated to educating the body, mind and spirit. Weekly News from Sacred Heart of Jesus School JANUARY 24, 2018 Calendar Peek!

More information

Thank you, in advance, for being a partner in your care.

Thank you, in advance, for being a partner in your care. 477 Cooper Road, Suite 220 Westerville, OH 43081 614-818-0215 Your appointment with: Dr. David H. Brown Dr. Jed W. Henry Dr. Adam J. Clemens is scheduled for. Welcome to our practice. It is our desire

More information